the MPR take:

The beta blockers carvedilol and metoprolol succinate have both been shown to reduce mortality in patients with heart failure (HF), but major guidelines do not recommend one individual drug over another. A study in the journal JAMA Internal Medicine evaluated patients with incident HF with reduced left ventricular ejection fraction (LVEF) (≤40%) who received either carvedilol (n = 6026) or metoprolol succinate (n = 5638) for both all-cause and cardiovascular mortality. After a mean follow-up of 2.4 years, the cumulative incidence of mortality was 18.3% and 18.8% for carvedilol and metoprolol succinate, respectively. While a few observational studies comparing the effectiveness of these two drugs on mortality risk in HF patients have been conducted, this cohort study of real-world patients in clinical practice presents stronger evidence of similar clinical effectiveness of these treatments.